According to a recent report in The Wall Street Journal, the pharmaceutical industry has been manufacturing the most highly advanced treatments for serious diseases, the most in nearly 2 decades. These treatments extend life expectancy and have fewer side effects than older treatments, but don’t always come without a cost, literally. United States spending on prescription medicines jumped 12.2% in 2014, the biggest percentage increase since 2001, according to the Centers for Medicare & Medicaid Services (CMS).

Cancer, hepatitis C, and multiple sclerosis treatments, among many others, can cost >$100,000 a year, which can cost patient thousands of dollar, annually. According to the CMS, out-of-pocket drug costs rose 2.7% in 2014. Many Americans in the lower class receive assistance of full coverage of medication prices by the government or financial assistance funds paid for by drug companies. However, those who fall under middle class are not eligible to receive the same assistance, but find that while they make too much to qualify for assistance, they do not make enough to afford these costly medications on their own. Often times, even those with comfortable incomes find themselves foregoing treatment or entering new debt and pulling funds from their savings in order to afford treatment.

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In The Wall Street Journal report, Peter Bach, physician, health-policy researcher, Memorial Sloan Kettering Cancer Center, New York, said, “Drugs are so expensive that once they flow through our ragtag insurance system, we have patients who can’t afford them, or they can barely afford them, so they’re not getting their therapies.”

Jacqueline Racener, a 76-year-old legal secretary, is a prime example. In February of 2015 her doctor prescribed her a new leukemia drug, Imbruvica^® (ibrutinib). Ms Racener qualified for Medicare, which covered some of the drugs expenses, but when she found out she would still be expected to pay nearly $8000 on her own per year. Ms Racener decided to take the risk and not fill her prescription. Ms Racener earned around $80,000 a year, between her job and social security. Her credit card debt, car note, and mortgage payment made the drug unaffordable. “There’s no way I could do that. It was just prohibitive,” she told the Wall Street Journal.

Ms Racener is not alone. More than half of ibrutinib users, who are on Medicare, are left with out-of-pocket costs of ≥$7000 a year, even after the federal insurance covers the bulk of the cost under the Part D prescription-drug plan. For those who have private insurance or insurance provided by an employer, out-of-pocket costs can vary from small co-pays to thousands of dollars. The Affordable Care Act topped commercially insured patients’ out-of-pocket costs for all health care, including drugs. The cap for 2016 is $6850.

While these aid programs may be beneficial for some, they come hand-in-hand with limits and restrictions for others.—Alessia D’Anna

Reference

Walker J. Patients struggle with high drug prices. The Wall Street Journal. January 4, 2016.